A VIEW FROM ABROAD
When Vision Prevails: A History of the International Society for Strategic Studies in Radiology Hedvig Hricak, MD, PhD, Dr hc, Hans G. Ringertz, MD, PhD, James H. Thrall, MD, Adrian K. Dixon, MD, Ronald L. Arenson, MD, William G. Bradley, MD, PhD, Ada Muellner, MS, Gabriel P. Krestin, MD, PhD Today, globalization is a wellrecognized phenomenon that affects innumerable aspects of daily life, including medical care. The drugs, medical devices, and imaging technologies on which national medical systems depend are developed in farflung parts of the globe. Although academic organizations, government agencies, and corporations from around the world both shape and are shaped by these developments, there are surprisingly few international forums for these stakeholders to meet, exchange ideas, and set broad strategies for the future. In this article, we reflect on the formation and evolution of the International Society for Strategic Studies in Radiology (IS3R), a nonpolitical, not-for-profit organization that brings together leaders from academia, government, and industry to communicate, plan strategically, and influence future developments in the field of medical imaging. Long before globalization became a household word, the visionary leaders behind the IS3R recognized that there were deep, common interests and concerns among medical imaging communities around the world. We hope that this history will illustrate the value of forums for multilateral, international discussions of health care and will inspire and
1112
provide a model for the development of more such forums.
CONCEPTION The seeds of IS3R were planted some 35 years ago at the first International Conference on the Impact of New Radiological Technology on Health Care, Research and Teaching, held in March 1978 in San Francisco. Born of the vision of Alexander R. Margulis, MD, then chair of the Department of Radiology at the University of California, San Francisco (UCSF), the conference was organized by a small committee of academic radiologists under his leadership. Its purpose, as Dr Margulis explained in his introductory remarks, was to “discuss the problems imposed on radiology, medicine in general, the medical schools, the leading hospitals and society as a whole, by the explosive advances in [radiological] technology.” At the time, health care costs accounted for approximately 9% of the gross national product of the United States and posed a significant burden in other developed countries as well. “CAT fever” had already spread worldwide, and technologies for ultrasound and nuclear medicine were rapidly increasing in sophistication, making radiology one of the largest areas of capital expenditures in health
care. The hope of the meeting organizers was that sharing ideas and experiences internationally would help develop practical approaches for deploying new imaging technologies before limits on their use were imposed from outside the imaging community. To address this ambitious agenda, the committee gathered together not only academic radiologists but also leaders from industry and government, deans, professors of medicine and surgery, basic scientists, and hospital directors. Although the majority of the 75 active participants came from the United States, 32 hailed from other countries scattered around the globe: Australia, Canada, Denmark, England, France, Germany, Israel, Japan, Mexico, the Netherlands, Norway, Spain, Sweden, and Yugoslavia. In individual lectures and panel discussions, the participants shared ideas and different national approaches for addressing a wide array of concerns, including the financing of new technologies, assessment of the cost-effectiveness of new technologies, control of the acquisition and use of new technologies within hospitals and health care systems, and the adjustment of training programs in light of new technologies. The exchanges were lively and enthusiastic, and as there was a general consensus that the meeting
1546-1440/15/$36.00
n
ª 2015 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2015.06.007
filled an important need addressed by no other forum, the UCSF Department of Radiology continued to present similar symposia every two to three years. By the time of the fifth symposium, in 1992, the organizing committee was large and international, and the meeting was attended by representatives from 22 companies in diverse parts of the world. The program now addressed concerns affecting emerging as well as developed countries, including outreach efforts to improve imaging and overall health care in the latter. In the mid-1990s, the roughly biennial symposium was no longer hosted solely by UCSF. It became geographically free floating and shifted somewhat in emphasis, returning to a greater focus on justifying the costs of imaging. To disseminate the ideas exchanged at the meetings, the proceedings were published in journals such as Academic Radiology and European Radiology [1-3], and executive summaries of the proceedings were sent to national radiology societies and relevant government agencies.
Birth of the IS3R The decision to form the nonprofit IS3R was made at the 1999 meeting in Berlin, partly to deal with the growing organizational demands of the meeting and its related outreach efforts. Statutes were established, and headquarters were designated in both the United States and Europe. Since the very beginning, the society has had a diverse international membership, including representation from Europe, the United States, and Asia, as well as strong relationships with industrial partners, who actively participate in its meetings. Corporate memberships for industry partners were introduced in 2003.
The broad mission of the society is to define and investigate strategic, scientific, and economic issues of global importance to the field of radiology. By forming a partnership between academia and industry, the society seeks to anticipate national and global developments in radiology and allied fields, define areas of common interest to both partners, and encourage cooperation. It aims to communicate important issues to radiologists, physicians in other medical fields, industry, and governments and to influence health care management and the flow of financial and human resources into the scientific and strategic fields most likely to advance biomedical imaging and patient care. The goal of increasing costeffectiveness while improving outcomes is implicit in the society’s mission and continues to lie at the heart of its wide-ranging discussions. The topics addressed have included everyday concerns faced by department chairs (eg, specialty-related turf battles, methods for improving workflow, challenges in the clinical implementation of IT), financial and regulatory pressures affecting research, needed changes in the education of imaging specialists, and new frontiers in imaging technologies and their potential synergy with advances in other biomedical fields. Starting with the fifth biennial meeting, the IS3R began to publish the proceedings of its meetings; thus far, they have all appeared in either Radiology or European Radiology, two of the most respected and widely read peerreviewed imaging journals [4-7]. The society continues to evolve, expanding the international diversity of its membership and adapting the meeting programs to address pressing new subjects. Yet the hallmark of the society’s operations and meetings
Journal of the American College of Radiology Hricak et al n A View From Abroad
remains open, multilateral peer discussion and consultation. This leads to better understanding of the needs of all stakeholders, not least those of radiologists and their industrial partners. In turn, this understanding should lead to a better deal for patients and the community in the form of lower costs, greater access, faster throughput, and improved diagnosis and therapy.
IMPACT AND CONCLUSION Much has changed since the first International Conference on the Impact of New Radiological Technology on Health Care, Research, and Teaching, but the subject of that conference is as timely as ever and will remain so as long as biomedical imaging continues to advance. Although it is impossible to measure the precise impact of the IS3R and the preceding symposia on the development of biomedical imaging around the world, the fact that leaders from the highest levels of academia, industry, and government agencies have found it worth their while to attend the symposia time and again over several decades is a strong indication of the society’s value. Through the IS3R, stakeholders who could easily see one another as competitors have developed friendships and a better understanding of how their needs can be aligned in the shared quest for high-quality, costeffective health care. Industry leaders who have attended have commented that the meetings provide a unique atmosphere, in which, instead of delivering a “sales pitch,” they feel free to engage in an open exchange of information. They have also expressed appreciation for the forward-looking perspectives of the society’s members and have said that the meetings often help them with their strategic planning. 1113
The IS3R meetings have sharpened leaders’ focus on many important emerging technologies, including digital imaging methods that have substantially transformed the field and functional and molecular imaging methods that have supported new directions in clinical practice and research that extend beyond the traditional borders of radiology. New and innovative ideas for improving the effectiveness and efficiency of health care gained traction in the medical imaging community after being presented at the IS3R meetings and likely influenced leaders’ decisions regarding which technologies and research areas to invest in. A look back at the sixth IS3R meeting in 2005 provides some evidence of the society’s prescience— and perhaps its ability to help set the course for change [4]. Topics discussed at the 2005 meeting that were exciting and novel at the time included the need for structured reporting, which is now being widely implemented; cost savings and care improvements obtainable through interinstitutional image sharing, which is now being provided through commercially run cloud-based sharing systems; computerized order entry with decision support, which is now embedded in US federal law and is coming to Europe; the potential for “data mining,” which is now being applied in the emerging discipline of radiomics; and the importance of
defining and using shared lexicons (such as the Systematized Nomenclature of Medicine and RadLex) for precise communication, which is now conceptually part of precision medicine [4]. The meeting also featured an extensive discussion of molecular medicine that presaged other precision medicine concepts, such as the use of imaging methods that target gene products to detect, localize, and quantify gene activity, in essence a form of functional genomics. Although the IS3R symposia were certainly not the first place these topics were presented, they were likely the first place many leaders in the radiology community and medical imaging industry heard about them in detail and had a chance to share their perspectives on them. There is no doubt that at the IS3R meetings and prior biennial symposia, leaders reinforced one another’s commitments to tackling difficult problems, such as standardizing evidence-based approaches to imaging, making large-scale changes in daily practice to incorporate advances in IT, and improving radiation safety. The advent of health care reform in the United States and other countries around the world has heightened the pressure to increase cost-effectiveness and develop better measures of outcomes. Thus, the question of how advances in medical technology can be incorporated into an economically viable health care
system has become still more urgent and complex. The IS3R, which continues to expand year by year, is an important reminder that reaching across organizational boundaries and national borders can help us find creative and practical answers.
REFERENCES 1. Costs and benefits of radiology: an international symposium. Oxford, England. Acad Radiol 1996;3(suppl 1):S1-161. 2. Second Oxford International Symposium on the Costs and Benefits of Radiology: San Francisco, California USA—August 21-23, 1997. Acad Radiol 1998;5(suppl 2):S255462. 3. Third International Symposium on the Costs and Benefits of Radiology: August 1921, 1999—Berlin, Germany. Eur Radiol 2000;10(suppl 3):S339-446. 4. Krestin GP, Miller JC, Golding SJ, et al. International Society for Strategic Studies in Radiology (IS3R). Reinventing radiology in a digital and molecular age: summary of proceedings of the Sixth Biannual Symposium of the International Society for Strategic Studies in Radiology (IS3R), August 25-27, 2005. Radiology 2007;244:633-8. 5. Muellner A, Glazer GM, Reiser MF, et al. Advancing radiology through informed leadership: summary of the proceedings of the Seventh Biannual Symposium of the International Society for Strategic Studies in Radiology (IS3R), 23-25 August 2007. Eur Radiol 2009;19:1827-36. 6. Bradley WG, Golding SG, Herold CJ, et al. Globalization of P4 medicine: predictive, personalized, preemptive, and participatory—summary of the proceedings of the Eighth International Symposium of the International Society for Strategic Studies in Radiology, August 27-29, 2009. Radiology 2011;258:571-82. 7. Krestin GP, Grenier PA, Hricak H, et al. Integrated diagnostics: proceedings from the 9th biennial symposium of the International Society for Strategic Studies in Radiology. Eur Radiol 2012;22:2283-94.
Hedvig Hricak, MD, PhD, Dr hc and Ada Muellner, MS, are from the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York. Hans G. Ringertz, MD, PhD, is from the Center for Medical Image Science and Visualization, Linköping University Hospital, Linköping, Sweden. James H. Thrall, MD, is from the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. Adrian K. Dixon, MD, is from the Department of Radiology, Addenbrooke’s Hospital, Cambridge, United Kingdom. Ronald L. Arenson, MD, is from the Department of Radiology, University of California, San Francisco, School of Medicine, San Francisco, California. William G. Bradley, MD, PhD, is from the Department of Radiology, University of California, San Diego, Medical Center, San Diego, California. Gabriel P. Krestin, MD, PhD, is from the Department of Radiology, University Hospital Rotterdam, Rotterdam, The Netherlands. Hedvig Hricak, MD, PhD, Dr hc: Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, Room C-276, New York, NY 10065.
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Journal of the American College of Radiology Volume 12 n Number 10 n October 2015
When Vision Prevails: A History of the International Society for Strategic Studies in Radiology Hedvig Hricak, MD, PhD, Dr hc, Hans G. Ringertz, MD, PhD, James H. Thrall, MD, Adrian K. Dixon, MD, Ronald L. Arenson, MD, William G. Bradley, MD, PhD, Ada Muellner, MS, Gabriel P. Krestin, MD, PhD Today, globalization is a wellrecognized phenomenon that affects innumerable aspects of daily life, including medical care. The drugs, medical devices, and imaging technologies on which national medical systems depend are developed in farflung parts of the globe. Although academic organizations, government agencies, and corporations from around the world both shape and are shaped by these developments, there are surprisingly few international forums for these stakeholders to meet, exchange ideas, and set broad strategies for the future. In this article, we reflect on the formation and evolution of the International Society for Strategic Studies in Radiology (IS3R), a nonpolitical, not-for-profit organization that brings together leaders from academia, government, and industry to communicate, plan strategically, and influence future developments in the field of medical imaging. Long before globalization became a household word, the visionary leaders behind the IS3R recognized that there were deep, common interests and concerns among medical imaging communities around the world. We hope that this history will illustrate the value of forums for multilateral, international discussions of health care and will inspire and
1112
provide a model for the development of more such forums.
CONCEPTION The seeds of IS3R were planted some 35 years ago at the first International Conference on the Impact of New Radiological Technology on Health Care, Research and Teaching, held in March 1978 in San Francisco. Born of the vision of Alexander R. Margulis, MD, then chair of the Department of Radiology at the University of California, San Francisco (UCSF), the conference was organized by a small committee of academic radiologists under his leadership. Its purpose, as Dr Margulis explained in his introductory remarks, was to “discuss the problems imposed on radiology, medicine in general, the medical schools, the leading hospitals and society as a whole, by the explosive advances in [radiological] technology.” At the time, health care costs accounted for approximately 9% of the gross national product of the United States and posed a significant burden in other developed countries as well. “CAT fever” had already spread worldwide, and technologies for ultrasound and nuclear medicine were rapidly increasing in sophistication, making radiology one of the largest areas of capital expenditures in health
care. The hope of the meeting organizers was that sharing ideas and experiences internationally would help develop practical approaches for deploying new imaging technologies before limits on their use were imposed from outside the imaging community. To address this ambitious agenda, the committee gathered together not only academic radiologists but also leaders from industry and government, deans, professors of medicine and surgery, basic scientists, and hospital directors. Although the majority of the 75 active participants came from the United States, 32 hailed from other countries scattered around the globe: Australia, Canada, Denmark, England, France, Germany, Israel, Japan, Mexico, the Netherlands, Norway, Spain, Sweden, and Yugoslavia. In individual lectures and panel discussions, the participants shared ideas and different national approaches for addressing a wide array of concerns, including the financing of new technologies, assessment of the cost-effectiveness of new technologies, control of the acquisition and use of new technologies within hospitals and health care systems, and the adjustment of training programs in light of new technologies. The exchanges were lively and enthusiastic, and as there was a general consensus that the meeting
1546-1440/15/$36.00
n
ª 2015 American College of Radiology http://dx.doi.org/10.1016/j.jacr.2015.06.007
filled an important need addressed by no other forum, the UCSF Department of Radiology continued to present similar symposia every two to three years. By the time of the fifth symposium, in 1992, the organizing committee was large and international, and the meeting was attended by representatives from 22 companies in diverse parts of the world. The program now addressed concerns affecting emerging as well as developed countries, including outreach efforts to improve imaging and overall health care in the latter. In the mid-1990s, the roughly biennial symposium was no longer hosted solely by UCSF. It became geographically free floating and shifted somewhat in emphasis, returning to a greater focus on justifying the costs of imaging. To disseminate the ideas exchanged at the meetings, the proceedings were published in journals such as Academic Radiology and European Radiology [1-3], and executive summaries of the proceedings were sent to national radiology societies and relevant government agencies.
Birth of the IS3R The decision to form the nonprofit IS3R was made at the 1999 meeting in Berlin, partly to deal with the growing organizational demands of the meeting and its related outreach efforts. Statutes were established, and headquarters were designated in both the United States and Europe. Since the very beginning, the society has had a diverse international membership, including representation from Europe, the United States, and Asia, as well as strong relationships with industrial partners, who actively participate in its meetings. Corporate memberships for industry partners were introduced in 2003.
The broad mission of the society is to define and investigate strategic, scientific, and economic issues of global importance to the field of radiology. By forming a partnership between academia and industry, the society seeks to anticipate national and global developments in radiology and allied fields, define areas of common interest to both partners, and encourage cooperation. It aims to communicate important issues to radiologists, physicians in other medical fields, industry, and governments and to influence health care management and the flow of financial and human resources into the scientific and strategic fields most likely to advance biomedical imaging and patient care. The goal of increasing costeffectiveness while improving outcomes is implicit in the society’s mission and continues to lie at the heart of its wide-ranging discussions. The topics addressed have included everyday concerns faced by department chairs (eg, specialty-related turf battles, methods for improving workflow, challenges in the clinical implementation of IT), financial and regulatory pressures affecting research, needed changes in the education of imaging specialists, and new frontiers in imaging technologies and their potential synergy with advances in other biomedical fields. Starting with the fifth biennial meeting, the IS3R began to publish the proceedings of its meetings; thus far, they have all appeared in either Radiology or European Radiology, two of the most respected and widely read peerreviewed imaging journals [4-7]. The society continues to evolve, expanding the international diversity of its membership and adapting the meeting programs to address pressing new subjects. Yet the hallmark of the society’s operations and meetings
Journal of the American College of Radiology Hricak et al n A View From Abroad
remains open, multilateral peer discussion and consultation. This leads to better understanding of the needs of all stakeholders, not least those of radiologists and their industrial partners. In turn, this understanding should lead to a better deal for patients and the community in the form of lower costs, greater access, faster throughput, and improved diagnosis and therapy.
IMPACT AND CONCLUSION Much has changed since the first International Conference on the Impact of New Radiological Technology on Health Care, Research, and Teaching, but the subject of that conference is as timely as ever and will remain so as long as biomedical imaging continues to advance. Although it is impossible to measure the precise impact of the IS3R and the preceding symposia on the development of biomedical imaging around the world, the fact that leaders from the highest levels of academia, industry, and government agencies have found it worth their while to attend the symposia time and again over several decades is a strong indication of the society’s value. Through the IS3R, stakeholders who could easily see one another as competitors have developed friendships and a better understanding of how their needs can be aligned in the shared quest for high-quality, costeffective health care. Industry leaders who have attended have commented that the meetings provide a unique atmosphere, in which, instead of delivering a “sales pitch,” they feel free to engage in an open exchange of information. They have also expressed appreciation for the forward-looking perspectives of the society’s members and have said that the meetings often help them with their strategic planning. 1113
The IS3R meetings have sharpened leaders’ focus on many important emerging technologies, including digital imaging methods that have substantially transformed the field and functional and molecular imaging methods that have supported new directions in clinical practice and research that extend beyond the traditional borders of radiology. New and innovative ideas for improving the effectiveness and efficiency of health care gained traction in the medical imaging community after being presented at the IS3R meetings and likely influenced leaders’ decisions regarding which technologies and research areas to invest in. A look back at the sixth IS3R meeting in 2005 provides some evidence of the society’s prescience— and perhaps its ability to help set the course for change [4]. Topics discussed at the 2005 meeting that were exciting and novel at the time included the need for structured reporting, which is now being widely implemented; cost savings and care improvements obtainable through interinstitutional image sharing, which is now being provided through commercially run cloud-based sharing systems; computerized order entry with decision support, which is now embedded in US federal law and is coming to Europe; the potential for “data mining,” which is now being applied in the emerging discipline of radiomics; and the importance of
defining and using shared lexicons (such as the Systematized Nomenclature of Medicine and RadLex) for precise communication, which is now conceptually part of precision medicine [4]. The meeting also featured an extensive discussion of molecular medicine that presaged other precision medicine concepts, such as the use of imaging methods that target gene products to detect, localize, and quantify gene activity, in essence a form of functional genomics. Although the IS3R symposia were certainly not the first place these topics were presented, they were likely the first place many leaders in the radiology community and medical imaging industry heard about them in detail and had a chance to share their perspectives on them. There is no doubt that at the IS3R meetings and prior biennial symposia, leaders reinforced one another’s commitments to tackling difficult problems, such as standardizing evidence-based approaches to imaging, making large-scale changes in daily practice to incorporate advances in IT, and improving radiation safety. The advent of health care reform in the United States and other countries around the world has heightened the pressure to increase cost-effectiveness and develop better measures of outcomes. Thus, the question of how advances in medical technology can be incorporated into an economically viable health care
system has become still more urgent and complex. The IS3R, which continues to expand year by year, is an important reminder that reaching across organizational boundaries and national borders can help us find creative and practical answers.
REFERENCES 1. Costs and benefits of radiology: an international symposium. Oxford, England. Acad Radiol 1996;3(suppl 1):S1-161. 2. Second Oxford International Symposium on the Costs and Benefits of Radiology: San Francisco, California USA—August 21-23, 1997. Acad Radiol 1998;5(suppl 2):S255462. 3. Third International Symposium on the Costs and Benefits of Radiology: August 1921, 1999—Berlin, Germany. Eur Radiol 2000;10(suppl 3):S339-446. 4. Krestin GP, Miller JC, Golding SJ, et al. International Society for Strategic Studies in Radiology (IS3R). Reinventing radiology in a digital and molecular age: summary of proceedings of the Sixth Biannual Symposium of the International Society for Strategic Studies in Radiology (IS3R), August 25-27, 2005. Radiology 2007;244:633-8. 5. Muellner A, Glazer GM, Reiser MF, et al. Advancing radiology through informed leadership: summary of the proceedings of the Seventh Biannual Symposium of the International Society for Strategic Studies in Radiology (IS3R), 23-25 August 2007. Eur Radiol 2009;19:1827-36. 6. Bradley WG, Golding SG, Herold CJ, et al. Globalization of P4 medicine: predictive, personalized, preemptive, and participatory—summary of the proceedings of the Eighth International Symposium of the International Society for Strategic Studies in Radiology, August 27-29, 2009. Radiology 2011;258:571-82. 7. Krestin GP, Grenier PA, Hricak H, et al. Integrated diagnostics: proceedings from the 9th biennial symposium of the International Society for Strategic Studies in Radiology. Eur Radiol 2012;22:2283-94.
Hedvig Hricak, MD, PhD, Dr hc and Ada Muellner, MS, are from the Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York. Hans G. Ringertz, MD, PhD, is from the Center for Medical Image Science and Visualization, Linköping University Hospital, Linköping, Sweden. James H. Thrall, MD, is from the Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts. Adrian K. Dixon, MD, is from the Department of Radiology, Addenbrooke’s Hospital, Cambridge, United Kingdom. Ronald L. Arenson, MD, is from the Department of Radiology, University of California, San Francisco, School of Medicine, San Francisco, California. William G. Bradley, MD, PhD, is from the Department of Radiology, University of California, San Diego, Medical Center, San Diego, California. Gabriel P. Krestin, MD, PhD, is from the Department of Radiology, University Hospital Rotterdam, Rotterdam, The Netherlands. Hedvig Hricak, MD, PhD, Dr hc: Memorial Sloan Kettering Cancer Center, Department of Radiology, 1275 York Avenue, Room C-276, New York, NY 10065.
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Journal of the American College of Radiology Volume 12 n Number 10 n October 2015
